Pulmonary metastasis of giant cell tumour: a retrospective study of three hundred and ten cases

BACKGROUND

Giant cell tumour (GCT) is an invasive benign bone tumour, and the incidence of pulmonary metastasis is rare. We are aiming to analyze risk factors of pulmonary metastasis and clinical prognosis for giant cell tumour patients with pulmonary metastasis.

METHOD

We performed a retrospective study of 310 patients with GCT between December 2004 and December 2016. Risk factors of pulmonary metastasis were analyzed by univariate and multivariate logistic regression analysis. Then, the influence of risk factors of overall LR (local recurrence), recurrent tumor at presentation, LR after our therapy, and with soft tissue mass on the pulmonary metastasis-free survival rates was analyzed.

RESULTS

The mean follow-up of the present cohort was 45.6 ± 35.3 months (median, 36.6 months; range, 6.1-193.4 months). Eighteen (5.8%) of 310 patients developed pulmonary metastasis. The average interval from surgery of primary tumour to detection of pulmonary metastasis was 15 months. Multivariate logistic regression analysis showed overall local recurrence was the independent risk factor of developing pulmonary metastasis. Among 18 patients with pulmonary metastasis, sixteen cases had history of local recurrence (88.9%, 16/18), including eleven (68.8%, 11/16) with local recurrence at presentation before receiving our therapy and seven (43.8%, 7/16) with local recurrence after receiving treatment in our hospital. Time to local recurrence had obvious difference between patients with and without pulmonary metastasis. Patients with pulmonary metastasis were prone to recur earlier. Furthermore, overall local recurrence, local recurrence after our therapy, recurrent tumor at presentation, and tumour with a soft tissue mass showed statistical differences in the pulmonary metastasis-free survival rates.

CONCLUSIONS

Giant cell tumour patients with soft tissue mass and overall local recurrence are prone to develop pulmonary metastasis. Although giant cell tumour is a benign tumor, more attention should be paid to the problem of pulmonary metastatic lesions, and chest CT scan should be recommended during follow-up.

Prevalence of primary spinal tumors: 15-year data from Siriraj Hospital

OBJECTIVE

To determine prevalence, demographic data and clinical presentation of primary vertebral tumors.

MATERIAL AND METHOD

A retrospective study of the primary spine tumor specimens from Siriraj bone tumor registry from 1996 to 2010.

RESULTS

From the study, primary spinal tumors constituted 85 of 1,679 bone tumor cases (5.06%). The common benign spinal tumors were giant cell tumor and hemangioma. The common malignant spinal tumors were chordoma, chondrosarcoma, and osteosarcoma. The mean age ofpresentation was 44.68 years. Fifty-three percent of tumors occurred in females. Pain was the most common presenting symptom, occurring in 73.53% of malignant and 52.94% of benign tumors. Neurological involvement occurred in 25% of malignant tumor Malignant lesions predominated in the sacral region while the most common location ofbenign specimens was thoracic region.

CONCLUSION

The present study was the first demographic study ofprimary spinal tumor in Thai showed variety of prevalence when compared with similar studies based on Western patients. Whether these results reflect differences in the population, race and data collection method.

[Analysis of the risk factors for local recurrence of giant cell tumor of long bone]

OBJECTIVE

The aim of the present study was to investigate the outcome of surgical management in patients with giant cell tumor (GCT) of extremity long bone and the risk factors for recurrence.

METHODS

Clinicopathological data of 145 patients with giant cell tumor of long bone treated in our hospital from 2002 to 2008 were retrospectively reviewed. There were 79 male and 66 female patients. The mean age at first diagnosis was 29 (11-66) years. There were 45 GCTs localized in the distal femur, followed by 36 in the proximal tibia, 22 in the proximal femur, 19 in the distal radius, 8 in the proximal fibula, 8 in the proximal humerus, 4 in the distal tibia and one in the distal fibula, distal humerus and proximal radius, for each. Surgical treatment included extensive curettage in 81 cases and resection in 64 cases. The possible risk factors for recurrence included age, gender, tumor location, Campanacci grading, pathologic fracture and types of surgery. The patients were followed up with a mean duration of 50 months ranging from 36 to 104 months. The correlation of age, gender, tumor location, Campanacci grading, pathologic fracture and types of surgery with the risk for recurrence was analyzed.

RESULTS

The overall local recurrence rate was 4.8% (7/145) and the mean duration for recurrence was 20 months ranging from 4 to 52 months. The local recurrence rate was 7.4% (6/81) in the extensive curettage group and 1.6% (1/64) in the resection group (P = 0.134). The difference was not statistically significant. Age, gender, tumor location, Campanacci grading, pathologic fracture and types of surgery were not risk factors for recurrence.

CONCLUSIONS

The results of the present study suggest that clinical and imaging features and types of surgery are not affecting factors for recurrence of giant cell tumor of long bone. Extensive curettage provides similar favorable local control of the tumor as resection. We would recommend extensive curettage while resection should be done following indications.

Giant Cell Tumor (tumor gigantocellularis, osteoclastoma) - epidemiology, diagnosis, treatment

The author presents the epidemiology, classification, clinical features and strategies of treatment of Giant Cell Tumor. Giant Cell Tumor of Bone accounts for 4-8% of primary bone tumors. It is most commonly seen in women aged 20 to 40 years. The most common sites are the distal femur and proximal tibia, distal radius, and proximal humerus. Increasing pain at the tumor site is the most common presenting symptom. Three types of GCT can be distinguished radiographically according to the Cappanacci or Enneking classification. The mainstay of treatment is total mechanical removal with curettage. The recurrence rate is high (12-50%) during the first 2-3 years after surgery, regardless of pre-operative tumor stage. 5-7% cases of giant cell tumor produce malignant recurrences, usually after five to more than 10 years after surgery.

Bone cement in the management of cystic tumour defects of bone at National Orthopaedic Hospital, Igbobi, Lagos

BACKGROUND

Cystic bony defects are characteristics of bone tumours especially benign ones e.g. Giant cell tumours of bone [GCT] and some metastatic tumours to bone. These patients present late with significant cystic cavities at a time the cost and availability of prosthetic implants to replace these defects sometimes precludes resection. The objective of this study is to evaluate the outcome of filling these defects with bone cement augmented with plate and screw for stability.

METHOD

A seven year prospective study was carried out in patients presenting with large cystic bony defects secondary to bone tumours at the oncology unit of the National Orthopaedic Hospital, Igbobi, Lagos. Data such as age, sex, anatomic location of lesions, histological type of tumours, x-ray findings, operation performed with the number of packets of bone cement used to fill the resultant bony defects were retrieved from prepared proforma. The average follow-up was 36 months.

RESULT

The proximal tibia and distal femur accounted for 42.9% and 28.6% respectively of the 14 patients studied. Giant cell tumour was the most common histological diagnosis 78.6%. Bone cement was effective in meeting the local requirements of limb salvage, early functional recovery and as a temporising measure until the patients can avail themselves of better options. The complication encountered was that of anaphylactic reaction in 2 scrub nurses.

CONCLUSION

Bone cement augmented with appropriate implants has proven valuable as a stop gap in filling large cystic bony defects resulting from tumours.

Clinicopathologic profile of 470 giant cell tumors of bone from a cancer hospital in western India

Over 20 years, 470 cases of giant cell tumor of bone diagnosed at a tertiary cancer hospital were analyzed. Male predominance (57%), predilection for bones around the knee joint (42%), and occurence in the 21- to 30-year-old age group (49.1%) with 6% being in the immature skeleton are well known facts. Accurate diagnosis was possible in 66% and 88% of cases on radiology and biopsy, respectively. Tumors measured 6 to 20 cm and, in 402 cases, showed "usual" histology comprising uniformly scattered multinucleate giant cells amidst mononuclear stromal cells, together imparting a syncitium-like appearance. Presence of osteoid, hemorrhage, and aneurysmal bone cyst-like areas; spindle cells in sheets (devoid of giant cells); or storiform pattern and intravascular osteoclasts were less common. The less common histologic features posed diagnostic difficulty in the setting of a small biopsy. Treatment included intralesional curettage (33.19%), marginal excision (4.2%), wide excision (31%), or radical surgeries (14.25%). Recurrences seen in 170 cases were multiple in 47 cases. Metastases largely to the lung were recorded in 24 cases. The histology of all the tumors, namely, primary, recurrent, or metastatic was identical. Statistical analysis using the computer software SPSS (SPSS Inc, Chicago, Ill)was performed with particular reference to the unusual histologic features vs recurrence and metastasis by chi(2) test. The only statistically significant factors were occurrence in the axial skeleton vs appendicular skeleton (P = .001) and primary treatment elsewhere vs at this hospital (P = .045), each of these being associated with increased frequency for local recurrence but not metastasis.

Giant cell tumor of bone in children and adolescents

BACKGROUND

There are very few series that document giant cell tumor of bone (GCT) in the immature skeleton, and the reported incidence in literature varies from 1.8% to 10.6%. The purpose of this study was to document the incidence of GCT in patients with open physis in the Indian population and study the course of the disease with respect to its adult counterpart to see if it behaved any differently.

METHODS

Between January 2000 and December 2005, 17 (6%) of 285 surgically treated patients with histologically proven GCT had open physis on imaging. Treatment was directed toward local control without sacrificing joint function, with most lesions treated with intralesional curettage.

RESULTS

Fourteen (82%) patients were girls. The most common site was around the knee (53%). Of 15 lesions in tubular bones, 13 were epiphysiometaphyseal in location. An open physis did not prevent GCT from penetrating the epiphyseal cartilage. Histologically, the tumors were typical of GCT. Of 15 patients available for follow-up, 3 (20%) developed local recurrence.

CONCLUSIONS

Although the overall incidence of GCT may be higher in the Asian population, the percentage of skeletally immature patients or those nearing skeletal maturity is similar to that described in literature. The biological behavior of the disease is similar to that seen in adults, except a marked female preponderance, principles of treatment, recurrence patterns, and course of the disease mirror the behavior of its adult counterpart.

Multicentric giant cell tumour of bone

Although giant cell tumour (GCT) is seen quite frequently, multicentric giant cell tumour (MCGCT) is a rare entity occurring in less than 1% of patients with GCT. The pathogenesis of MCGCT is debated; various mechanisms have been postulated, including contiguous spread, iatrogenic tumour cell seeding, benign metastasis, malignant transformation and de novo formation. A literature review revealed 101 cases of MCGCT reported worldwide, of which we could trace and review 83 cases. We noted that MCGCT, unlike the solitary GCT, more frequently involves the short bones of the hand and feet and is commoner in the meta-diaphyseal region of long bones. The present literature review noted a higher incidence in females and skeletally immature patients (21%). Individual lesions in a patient with MCGCT are radiologically and histologically indistinguishable from the solitary GCT. In our review we noted 42 recurrences in 157 lesions (26%), thus negating the commonly held point of view that MCGCT was clinically more aggressive. Four lung metastases and two histologically malignant lesions were found. The literature does not define the exact time period beyond which a lesion can be classified as metachronous; however a significant number of the subsequent lesions occur within 2-3 years of the index lesion. We recommend from our review, that with the present state of knowledge, special care should be taken in cases with primary meta-diaphyseal lesions, GCTs seen at atypical locations, and in females of younger age group, to ensure that multicentricity is picked up earlier.

Familial risk for histology-specific bone cancers: an updated study in Sweden

We used the nation-wide Swedish Family-Cancer Database to examine the familial risks of histology-specific bone cancers in offspring by parental or sibling probands. Adjusted standardised incidence ratios (SIRs) were used to measure the risk. Among the 1327 offspring bone cancers, only two parent-offspring pairs and one sibling pair were noted with concordant bone cancer but the SIRs were not significant. Significant associations were observed in specific histological types or specific age groups, some of which may be chance findings arising from multiple comparisons. However, the risk of early-onset (< 25 years) osteosarcoma in offspring was significantly increased when mothers presented with breast cancer (1.7) and melanoma (2.9), suggesting that Li-Fraumeni syndrome could partly explain this familial aggregation. Other associations, such as childhood osteosarcoma with parental liver cancer, Ewing's sarcoma with kidney cancer and giant cell sarcoma with maternal breast cancer, were novel findings and may be related to other familial diseases.

Use of short implants for functional restoration of the mandible after giant cell tumor removal. Case report

The giant cell tumor of the jaws is a rare benign lesion, it has a slow and progressive evolution and it is locally aggressive. Its etiopathogenesis is unknown, it is most common in the mandible and it is often asymptomatic but pain arises from palpation of the area. Diagnosis is made by radiological and histological examination and surgical treatment is necessary. The clinical case of a 28-year-old man affected by a giant cell tumor of the mandible with an aggressive clinical and radiographical behaviour is reported. The patient showed a jaw swelling covered by hyperemic fibro-mucous tissue from tooth 4.6 to 3.4, absence of cortical bone and mobility of teeth. He also reported lip anesthesia. The giant cell tumor diagnosis was made with orthopantomography (OPT), computed tomography (CT) and needle biopsy. The lesion was surgically removed and histological examination confirmed the diagnosis. In spite of the wide loss of bony substance after surgery, the patient was provided with an implant supported fixed prosthesis without previous bone graft. In this case short implants allowed the prosthetic rehabilitation of a mandible with severe ''resorption'' due to surgical removal of a tumor. Implants were placed in the residual bone volume and successfully used to support a fixed prosthesis. The final result is optimal as is the quality of life of the young patient.

Giant cell tumor of bone

Giant cell tumor is a common benign bone tumor that possesses specific features including location at the end of long bone, a strong tendency toward local recurrence, and the rare capacity to metastasize to the lungs. Preferred treatment usually consists of extensive curettage and filling of the cavity with bone graft or cement. Debate still exists about the usefulness of local adjuvant treatment. Functional outcome is usually very good.

Malignancy in giant cell tumor of bone

BACKGROUND

The term malignant giant cell tumor embraces multiple entities and therefore can be confusing. The goals of the current study were to define the clinicopathologic and histologic features of malignancy in giant cell tumors and to clarify the terminology.

METHODS

The authors reviewed all cases from the Rizzoli Institute (Bologna, Italy) of primary (PMGCT) and secondary (SMGCT) malignancy in giant cell tumors. PMGCT is a high-grade sarcoma that arises side by side with benign giant cell tumors. SMGCT is a high-grade sarcoma that occurs at the sites of previously treated giant cell tumors of bone.

RESULTS

The authors report 5 PMGCTs and 12 SMGCTs; half of the SMGCTs were postradiation sarcomas. Patient age ranged from 20 to 68 years (median, 62 years) for PMGCT and from 30 to 77 years (median, 40 years) for SMGCT. The average latent period between diagnosis of giant cell tumor and diagnosis of SMGCT was 9 years (range, 3-15 years) for patients with postradiation SMGCT and 19 years (range, 7-28 years) for patients with SMGCT resulting from spontaneous transformation. The histologic classification of high-grade sarcomas in the PMGCT group was osteosarcoma in four cases and malignant fibrous histiocytoma in one case. In the SMGCT group, the histologic classification was osteosarcoma in nine cases, fibrosarcoma in two cases, and malignant fibrous histiocytoma in one case. The outcomes associated with all malignancies in giant cell tumors were poor, with the worst outcome associated with postradiation SMGCT.

CONCLUSIONS

Malignancies in giant cell tumors of bone always are high-grade sarcomas with a poor prognosis. These lesions must be distinguished from benign giant cell tumors of bone. SMGCT usually is easy to diagnose upon malignant clinicoradiographic presentation. In contrast, PMGCT often mimics giant cell tumors both clinically and radiographically. In addition, upon histologic examination, PMGCT shows areas of conventional giant cell tumor, which can lead to difficulties in making the correct diagnosis.

Giant cell tumor of the bones of the hand and foot

BACKGROUND

Giant cell tumor of the small bones of the hand and foot is suspected of having some peculiar features compared with giant cell tumor in other sites. Moreover, it could share some features with other giant cell rich lesions involving the hand and foot, and this may affect the differential diagnosis. The aim of this study was to analyze the features of lesions such as these in the files of the Rizzoli Orthopedic Institute.

METHODS

The incidence of giant cell tumors of the bones of the hand and foot seen at the Rizzoli Orthopedic Institute over 50 years (1947-1997) was taken into consideration. There were 8 lesions of the hand and 21 of the foot. Clinical information and follow-up of the patients were studied and updated. Radiographs were studied and radiographic features analyzed. Histopathologic material was thoroughly reviewed and histologic features analyzed.

RESULTS

Although the location of tumor was helpful information, radiographic features were not specific. Giant cell tumors of the small bones of the hand and foot showed a predominance in females, younger patients and more aggressive behavior than giant cell tumors of large bones. The authors did not observe multicentricity or pulmonary metastases.

CONCLUSIONS

Because the radiographic features of giant cell tumor of the hand and foot overlap those of other giant cell rich lesions in these locations, histologic diagnosis is mandatory, although it may be difficult and require the establishment of diagnostic criteria for giant cell tumor. As this tumor tends to be more aggressive than other giant cell rich lesions, treatments of choice are aggressive curettage or resection.

Comparative frequency of bone sarcomas among different racial groups

OBJECTIVE

To analyse comparatively the relevant data from bone tumor registries in China, Japan, and the United States.

METHODS

The data of 38,959 histologically confirmed primary bone tumors collected by the Chinese Bone Tumor Registry 1957-1988, 20,272 collected by the Japanese Bone Tumor Registry 1972-1990, and 11087 diagnosed and treated at Mayo Clinic, USA were used for comparative analysis by race, age, sex and skeletal distribution. For reliability, we used ratios of different tumors to osteosarcoma for frequency analysis. We also included some data from the SEER 1973-1987 as well as from Memorial Sloan-Kettering Cancer Center, USA.

RESULTS

The relative frequency of osteosarcoma (OS) is higher in China and Japan than in the United States. There were only limited number of OS patients aged over 50 years in Chinese and Japanese groups, which might be due to the lower incidence of OS subsequent to Paget's disease in Asians. More osteosarcoma occurred in the flat bones in the Americans than in the Chinese and Japanese. The relative frequency of chondrosarcoma (CS) was higher in the American group than in the Asian groups. The average age of CS patient was younger in the Chinese than in the Japanese and the Americans. The data confirmed the previous report that the incidence of Ewing sarcoma was higher in western people than in Asians. The data showed that the comparative frequency of chordoma is higher in the Americans than in the Asians and that the incidence of giant cell tumor of bone is higher in the Chinese and Japanese than in the Americans.

CONCLUSIONS

The findings from this analysis provide useful information for the epidemiologic study and the clinical diagnosis of bone tumors.

Treatment of giant-cell tumors of long bones with curettage and bone-grafting

BACKGROUND

The use of curettage, phenol, and cement is accepted by most experts as the best treatment for giant-cell tumor of bone. The present study was performed to evaluate whether equivalent results could be obtained with curettage with use of a high-speed burr and reconstruction of the resulting defect with autogenous bone graft with or without allograft bone.

METHODS

The prospectively collected records of patients who had a giant-cell tumor of a long bone were reviewed to determine the rate of local recurrence after treatment with curettage with use of a high-speed burr and reconstruction with autogenous bone graft with or without allograft bone. All of the patients were followed clinically and radiographically, and a biopsy was performed if there were any suspicious changes.

RESULTS

Fifty-nine patients met the criteria for inclusion in the study. According to the grading system of Campanacci et al., two patients (3 percent) had a grade-I tumor, twenty-nine (49 percent) had a grade-II tumor, and twenty-eight (47 percent) had a grade-III tumor. Seventeen patients (29 percent) had a pathological fracture at the time of presentation. The mean duration of follow-up was eighty months (range, twenty-eight to 132 months). Seven patients (12 percent) had a local recurrence. Six of these seven were disease-free at the latest follow-up examination after at least one additional treatment with curettage or soft-tissue resection (one patient). One patient had resection and reconstruction with a prosthesis after a massive local recurrence and pulmonary metastases.

CONCLUSIONS

Despite the high rates of recurrence reported in the literature after treatment of giant-cell tumor with curettage and bone-grafting, the results of the present study suggest that the risk of local recurrence after curettage with a high-speed burr and reconstruction with autogenous graft with or without allograft bone is similar to that observed after use of cement and other adjuvant treatment. It is likely that the adequacy of the removal of the tumor rather than the use of adjuvant modalities is what determines the risk of recurrence.

Giant cell tumors of the jugular foramen

PURPOSE

To review the diagnosis and treatment of giant cell tumors of the jugular foramen.

MATERIALS AND METHODS

A typical case is reported. Symptoms, signs, and diagnostic studies are reviewed. Photomicrographs and angiographic studies showing the differences between these and glomus jugulare tumors are provided. A coherent approach to their management is presented.

RESULTS

These hypervascular, traditionally radioresistant tumors may cause pulsatile tinnitus, conductive hearing loss, and lower cranial nerve paresis. Angiographic studies showed a hypervascular lesion supplied by numerous small branches of the external carotid artery, making embolization difficult. Complete resection was achieved by an infratemporal fossa approach with preoperative embolization.

CONCLUSION

Giant cell tumors of the temporal bone may mimic glomus jugulare tumors with respect to anatomic location, cranial nerve deficits, and vascularity.

Paget's disease of bone complicated by giant cell tumor

Paget's disease is uncommon in patients younger than 50 years of age. Multifocal giant cell tumors arising in bone affected by Paget's disease have been described previously in 37 cases. A case of a 38-year-old man with polyostotic Paget's disease and multifocal giant cell tumors responsive to steroid therapy is presented.

Malignant giant cell tumour of the distal femur treated by excision, allografting and ligamentous reconstruction: an 18-year follow-up

Extensive osteoarticular allografts have been used for knee reconstruction, but because of their composite nature and the technical difficulty of the procedure, complication and failure rates have been high. There are few records of long-term results in the literature. In this report, a 19-year-old man with a large aggressive giant cell tumour of the left distal femur was treated in 1976 by en bloc resection, massive femoral allografting and ligamentous reconstruction. Follow-up after 18 years showed no recurrence of the tumour, excellent incorporation of the graft and good knee function, which allowed the patient to work 9 hours a day on his feet without pain.

Clinical, statistical and immunocytochemical characterization of giant cell tumour of bone amoung Egyptian population

Clinical and immunocytochemical analysis of twenty eight cases of giant cell tumour of bone was performed in this study. The results revealed that nine of the cases were benign, while the other nineteen were malignant. The female to male ratio was 2.5:1. The average age incidence was 28.18 years. The most common site of occurrence was the femur. anti endothelial antibody revealed negative immunocytochemical reaction of the stromal cells and giant cells for both benign and malignant cases; While using anti-HLA-DR antibody demonstrated positive immune reaction of some of the strumal and giant cells of all the cases examined.